Cost-efficiency of endoscopic and external dacryocystorhinostomy

Anari, Shahram; Ainsworth, G.; Robson, Andrew

doi:10.1017/s0022215107009954

Cited by 23 publications

(16 citation statements)

References 11 publications

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“…[12][13][14] In our opinion, the fact that endoscopic DCR carries a success rate comparable to the external approach, does not preclude subsequent external DCR for surgical failures, and is preferred by patients 15 suggests it to be preferable as the first-line treatment. Our respondents indicated that they perceived a good success rate with endoscopic DCR but, nevertheless, recognised the higher success rate of the 'gold standard' of external DCR.…”

Section: Discussionmentioning

confidence: 87%

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Al-Shaikh

Javed

Fincham

et al. 2010

annals

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INTRODUCTION The objective of this study was to evaluate the current involvement of ear, nose and throat (ENT) surgeons in lacrimal surgery. SUBJECTS AND METHODS A postal survey was distributed to 796 practicing UK consultant otorhinolaryngologists listed at the drfoster website. RESULTS Overall, 531 questionnaires were returned, giving a response rate of 66.7%. Of these, 108 (20.6%) respondents indicated they were involved in lacrimal surgery. The majority of otolaryngologists seem to work in collaboration with ophthalmologists. In our survey, 98% (106) perform endoscopic dacryocystorhinostomy (DCR). Most respondents believed lacrimal intubation and dilation to have limited success, endoscopic DCR to have moderate success and external DCR to have high success. CONCLUSIONS Lacrimal surgery is carried out in a spirit of collaboration with ophthalmologists rather than competition. Endoscopic DCR is the favoured surgical procedure of otolaryngologists. The perceived success rate for endoscopic DCR reported in this survey coincides with that reported in the literature.

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Section: Discussionmentioning

confidence: 87%

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Al-Shaikh

Javed

Fincham

et al. 2010

annals

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“…This, combined with excellent cosmetic results, shorter operating times and better cost-efficiency has led to endonasal DCR being the procedure of choice in many patients with nasolacrimal obstruction (Anari et al, 2008;Dolman, 2003). Nevertheless, a small proportion of procedures fail.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Anatomical Patency Following Primary Endonasal Dacryocystorhinostomy: A Pilot Study

Davies

Lee

Lemke

et al. 2011

Orbit

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Greater flap mobility and greater lacrimal sac marsupialization in endonasal DCR are associated with better rates of early anatomical patency. A novel scoring system incorporating mobility, marsupialization and bony clearance also showed a significant relationship to early outcome, with higher scores being associated with better outcomes. These results may enable greater understanding of the perioperative features associated with better outcomes in endonasal DCR.

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“…Our review has also shown that endonasal DCR had significantly shorter operative time as compared with external DCR. Moreover, local anaesthesia can be used for endonasal DCR, 4 leading to a higher number of cases that can be done in each theatre session, 17,21 as well as being able to be done as day cases 4,21 . Local anaesthesia expands the population eligible for this procedure, as it allows older and less fit patients 21 as well as inpatients for whom hypotensive anaesthesia is not advisable to safely undergo surgery 16 .…”

Section: Discussionmentioning

confidence: 99%

“…He has also performed and taught endonasal DCR in remote clinics in northern Canada and in several developing nations 6 . A study reported that endoscopic endonasal DCR generated approximately twice as much income as external DCR and hence was more cost‐effective mainly due to the higher number of cases per session, day case operations and using local anaesthesia 21 …”

Section: Discussionmentioning

confidence: 99%

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

Lee

Chai

Loon

2010

Clinical Exper Ophthalmology

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This paper aims to compare the efficacy, mean operative time and adverse effects of primary external dacryocystorhinostomy (DCR) versus primary endonasal DCR in treating acquired nasolacrimal duct obstruction. Searches were performed for studies comparing the two procedures. Two reviewers independently extracted data from 14 eligible studies. A random effects model was used to analyse the studies. Outcome measures were defined as patency of the nasolacrimal canal and mean operative time, and adverse effects as cutaneous scarring and bleeding. Both procedures were comparable in efficacy in terms of full success, partial success and anatomic patency. Subgroup analysis showed no significant difference between prospective and retrospective studies as well as between non-laser endonasal DCR versus external DCR and laser endonasal DCR versus external DCR. Endonasal DCR had a significantly shorter mean operative duration, be it laser endonasal DCR (mean difference: 37.65 min, 95% confidence intervals: 3.54-71.75 min, P: 0.03) or non-laser endonasal DCR (mean difference: 19.22 min, 95% confidence intervals: 2.15-36.28 min, P: 0.03). The odds of postoperative bleeding was not significantly different between the two procedures, whereas postoperative cutaneous scarring was unique to external DCR and occurred in 50 out of 402 (12.44%) external DCRs recorded. Endonasal DCR has comparable success rates with external DCR and has a shorter operative time and no cutaneous scar. However, drawbacks include the steep learning curve and higher costs.

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Cost-efficiency of endoscopic and external dacryocystorhinostomy

Cited by 23 publications

References 11 publications

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Predictors of Anatomical Patency Following Primary Endonasal Dacryocystorhinostomy: A Pilot Study

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

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